December 8, 2005 - Phoenix New Times (AZ)

Meth Treatment

Meth Addiction Isn't Impossible To Beat -- But The Treatment's
Not Cheap. And Good Luck Finding It

By Sarah Fenske

Pretty, blond, and poised, Jamie doesn't look like a
meth addict. But she's been using for four years, since she was 19. She
smoked some this morning. She smokes some every day.

She has to.

"I need it every morning to get started, and
then on my lunch hour," she confesses. After her shift ends at the
Phoenix call center where she works, she sometimes smokes again. "It
depends on how much I have."

In some ways, Jamie is a meth success story: She has
a job. She's never been arrested. She's not hideously pocked. Her teeth
are straight and white.

But she knows full well the toll meth has taken on
her: the cars repossessed, the jewelry pawned, the jobs lost.

Most of all, she hates that she's still under its
power.

This is the most stable she's been in years. When she
was with her boyfriend, the guy who got her started, things were crazy. He
stole her mother's credit cards to buy meth.

They'd get spun on meth for days on end.

She didn't realize she was pregnant until she was
almost six months along. He gave her stolen money orders to pay Planned
Parenthood for the abortion. (She later repaid the money.)

A "friend" shot him, right in the gut.
Still, they kept using.

She loved the high.

"I felt like I could do anything," she
says. And she loved that it made her thin. She'd never been fat -- curvy,
maybe. But her mom is a flight attendant, with the model-thin body that
goes with the job. Jamie loved being just as skinny.

Her mother, Connie Irvine, was devastated.

She'd been a hands-on mom, even moving from Tempe to
Ahwatukee because she thought the old neighborhood was going downhill. She
wanted to shield her daughter from gangs and drugs.

Jamie, Irvine recalls, was a good kid who graduated
high school a year early. Before she started using, her bedroom had
prominently featured a "Tweakers Suck" poster.

"For all this to happen to my girl because of
meth -- it was like she was bulletproof," Irvine says. "She was
so ambitious. Everything was perfect for her. She was so determined. And
then . . ."

There was hope for Jamie. She wanted to quit. With
the right program, both mother and daughter are convinced she could have
made it.

But both times Jamie packed her bags for rehab, the
day ended in disappointment.

She never actually made it through the door.

At the first place, the director said they'd take
her, but only if she tried Narcotics Anonymous first, and then outpatient
therapy.

Jamie thought that was ridiculous. She knew she
needed a total lifestyle change. She was smoking again later that day.

Later, mom and daughter went to the Salvation Army,
which runs one of the few inpatient rehab centers for people who can't
afford to pay.

But they wanted Jamie to pass a drug test before
they'd admit her. And since she'd smoked that morning, she couldn't pass
it.

That was on a Thursday. If she could stop using until
Tuesday morning, they told her, they'd let her in.

Connie Irvine fretted.

"I'll call in sick," she told her daughter.
"I'll be your shadow all weekend."

Jamie vowed she had it under control.

And so she did, through the weekend. She made plans
to come to her mother's house Tuesday morning and they'd drive over
together.

That morning, Connie Irvine got up and got ready to
go.

She waited, and then, as her heart sank, she waited
some more.

Jamie never showed up.

She was smoking again.

For the families caught in the middle, meth addiction
can be a horrific roller coaster. Every promise to quit seems so sincere
-- and maybe it is.

Often, though, it all ends in letdown.

"It's not even so much a matter of fun,"
says Mark, a construction worker who says he used meth "daily"
from 1997 until a year ago. "Over a period of time, it's just
impossible to get out of bed without it."

Politicians will tell you the drug is almost
impossible to kick. "It's so highly addictive, you use it once, and
you could be hooked," says Phoenix Councilman Dave Siebert.

Siebert's not alone. The idea of meth being a
"super drug" that traps one-time users for life gets repeated
again and again by lawmakers and their spokesmen. One oft-quoted statistic
claims that no more than 1 to 5 percent of meth users manage to get clean.

It's one reason, perhaps, that politicians are so
willing to ignore the treatment issue and instead focus on easier
initiatives, like busting meth labs (see "Bad Medicine").
Treatment, the theory goes, is just a money pit.

The only problem?

It isn't true. Statistics overwhelmingly point to a
more complex reality: Meth addiction is hard to treat, but can, in fact,
be treated as successfully as drugs like cocaine and pot.

Which means that 5 percent figure is pure bunk.

"When asked about the source of numbers,
speakers are uncertain about their origin," Richard Rawson, associate
director of the UCLA Integrated Substance Abuse Programs, writes in a
recent report on the topic. "In fact, no such data exist."

Rawson questions the motives of politicians who
insist crystal meth can't be treated.

"The resulting conclusion is that spending money
on treating methamphetamine users is futile and wasteful."

As treatment advocates point out, what Health and
Human Services data actually show is that more than 12 million people have
used crystal meth at least once. Only 5 percent of those 12 million --
fewer than 500,000 -- have used it in the last month.

How is that possible?

The others didn't get hooked after one snort. Or they
managed to quit.

That's a better percentage than people who tried
cigarettes, notes Reena Szczepanski, executive director of New Mexico's
Drug Policy Alliance, which pushes for legalizing marijuana but not harder
drugs like cocaine and meth. The group is committed to fighting all drug
abuse through treatment rather than prosecution.

"It's not helpful to say meth is so powerful you
can't treat it," she says. "We've been through this with
cocaine, with crack. It's something we say with every drug that comes
along and is suddenly popular.

"But we've talked to treatment providers. And
overwhelmingly, they say, you can treat this."

For example: The Iowa Consortium for Substance Abuse
Research and Evaluation surveyed 362 drug addicts who were treated in
2003. Six months after discharge, 65 percent of meth users were still
clean.

That doesn't mean that it's easy to kick meth
addiction -- or that there's even overwhelming research in support of the
programs considered most successful.

Scientific studies of alcohol rehabilitation models
are relatively common; studies that look solely at meth users are not.
Some studies do measure how many meth addicts complete treatment, or how
many pass drug tests at the end of the treatment period.

Few follow up with their subjects even a full year
later.

There are some things that people in the treatment
community, however, mostly agree on.

One is that meth addiction is, in fact, more
difficult to treat than alcohol addiction.

Another is that it's more expensive.

And the third is that no one -- from insurance
companies to taxpayers -- wants to foot the bill.

Like cocaine, crystal meth is not physically
addictive. Someone who's coming off a bender will have to sleep, sometimes
for days on end. But they won't be experiencing a heroin-style detox.

It should make things easier -- but in some ways, it
doesn't.

Treatment workers say serious meth abusers alter
their brain chemistry so much that they can feel "foggy" for as
long as two years, even after quitting.

"You're not going to recover from meth overnight
or even in a year," says Ken Lucas, a spokesman for Valley Hope
Arizona, which runs four inpatient facilities in the Phoenix area.
"You're rewiring the brain, much more so than with heroin or alcohol
or cocaine."

Treatment providers believe inpatient therapy is key.

"It really takes a dramatic change in
lifestyle," Lucas says.

"If you're addicted, outpatient therapy is like
throwing money from a moving car," agrees Jeffrey Taylor, a counselor
and program advocate for the Phoenix Rescue Mission.

But few insurance providers will fund lengthy
inpatient treatment.

Many require addicts try outpatient first, to prove
they're serious by attending meetings. Even if they manage to do that, and
get into treatment, few insurance plans cover more than a one-month stay.

It's just not enough.

"A 28-day program is not going to do any good
with a crystal meth addict doing 10 big lines a night," Taylor says.
"You've got to have six months or even a year."

Taylor's program, the Phoenix Rescue Mission, is one
of the rare inpatient programs for indigents -- and it's willing to house
them for years at a time.

But Taylor's only got 20 beds.

Programs like Valley Hope Arizona, meanwhile, cost
$10,000 a month. So when insurance runs out, many addicts have no choice
but to leave, vowing to make it with outpatient therapy sessions.

Maybe they're on the road to recovery. But it's hard
not to go back when their friends start calling again.

"A lot of people go right back to their old
playpens," Lucas says.

And those are the ones who make it to inpatient
treatment in the first place.

A big problem, on a practical level, is that meth
addicts often hit rock bottom much more quickly than drunks. Don Nichols
is CEO of the Arizona Treatment Institute in Casa Grande, which does
intensive outpatient treatment.

Alcoholics who come for treatment are typically
employed, Nichols says, which means they can opt for a month's stay
covered by insurance.

That's not true of meth users.

"Most of them are not going to be working by the
time they come to treatment," he says.

For the truly indigent, the Arizona Department of
Health Services provides treatment -- in Maricopa County, there are about
400 meth addicts under the care of ValueOptions.

In recent years, the department has seen the number
of meth users in its system explode, says Christina Dye, the clinical
services division chief. It's now working to tailor treatment for those
people.

But there just isn't money to do everything they'd
like.

For example: Dye's division is devoting more than $2
million in 2006 to train its substance abuse providers under a system
pioneered by the California-based Matrix Institute.

Thanks to its clinic in San Bernardino County, an
area popular with bikers and thereby a longtime crystal meth hot spot,
Matrix has carefully studied meth addiction. Its directors understand the
challenges of keeping meth addicts coming to outpatient treatment.

Rehab depicted in the movies typically shows
alcoholics working through family issues and confronting, say, their
absent father. But Matrix associate director Michael McCann says his
program determined that didn't work for outpatient therapy.

"If you take people this fragile and send them
home after a session like that, more often than not, they're going to dive
back into using again," McCann says.

Instead, the focus is on cognitive behavior skills.
Learning to think differently. Learning to take control.

"The key," McCann says, "is often just
making sure they come back the next time."

But despite the program's success, the health
department won't be able to roll out training for it statewide in 2006,
Dye says.

In fact, the division didn't receive any new funding
to pay for it. It had to "find" the $2 million it plans to spend
by cutting in other areas. And that's only enough for four pilot areas.

Maricopa and Pima counties were fortunate to be one
of them. Addicts in Flagstaff aren't so lucky.

Alishia Hight used meth for the first time when she
was 12, and by the time she should have graduated high school, she was a
mess: Dating loser older guys because they had drugs. Staying up for days
on end. Shooting the stuff straight into her veins.

"I didn't know how to drive, so I'd walk around
people's neighborhoods and steal stuff from their cars," she admits.

Then she got booked on a series of felonies -- all
related to drug possession, but enough of them to be serious.

It wasn't her first brush with the law, but it was
the first time the court gave her a choice: inpatient rehab or jail.

It was probably only because she was five months
pregnant. (State health department guidelines give pregnant women priority
for substance abuse treatment.)

But it worked.

She originally thought she'd be stuck in New Arizona
Family for just 30 days. After she got there, though, they told her she
was staying put until the baby was born. And so she did, and then she
stayed for another five months.

In rehab, she learned the things she'd missed in her
years of snorting and shooting. She learned how to live.

In jail, she'd heard other girls talking about
getting their babies back from Child Protective Services. She thought
about the kids she'd seen, hanging around, while she and her friends were
snorting meth.

She's stayed clean. Two years after her son was born,
she married a guy who had also stopped using meth.

Now they have another little boy. They're both going
to school and working.

"I wanted a family," Hight says. "And
I don't want to do anything to mess that up."

But the courts don't take every case as seriously as
they took Hight's.

The system can't afford it.

New Arizona Family has just 30 beds. In Hight's case,
having a baby made her eligible for the government assistance that helped
finance her stay.

If she hadn't been pregnant, her best hope
undoubtedly would have been outpatient treatment.

Studies suggest she would have had a much harder time
making it.

A 2005 study from UCLA's Integrated Substance Abuse
Programs, published in the American Journal of Drug and Alcohol Abuse,
surveyed 350 meth users.

It found little statistical difference between
patients who'd come to rehab because they were forced by court order and
those who came willingly.

Overall, 70 percent of users relapsed within two
years.

But 30 percent made it. And it's worth noting the
factors that made a difference.

The study found a significant relationship between
longer treatment times and success. "The strongest predictor,"
the authors reported, "is the number of months in treatment, with
longer time in treatment associated with more positive outcomes."

Also significant: Addicts assigned to inpatient
programs were 2.4 times greater to finish treatment.

It's obvious why courts don't mandate inpatient
programs for everyone. With such programs being as expensive as they are,
most defendants would probably just end up back in jail because they
couldn't afford to comply.

Tammy Quarelli, a substance abuse counselor with
Dynamic Living, gets most of her clients through court order.

She claims good success with meth users, even on an
outpatient basis, if she can get patients who are mandated to see her for
six months.

But many probation officers set the bar much lower,
she says.

"I get so mad when I see a referral for two
months," Quarelli says. "The physical part, you can get done
with that in a few days. But the psychological part -- that just goes on
and on."

At 21, Georganne Bickle's daughter has been using
meth for five years. In the photograph Bickle carries in her wallet, the
girl is fresh-faced and beaming at her high school graduation, a perky kid
in white robes and a funny hat.

"She was a beautiful girl." Now her skin is
pocked with the sores that plague serious meth addicts: "She's got
meth bites."

Bickle's daughter, whom Bickle asked New Times not to
name, once dreamed of being an actress. Instead, she's working as a
stripper.

She's been to the emergency room, after taking meth
mixed with rat poison. She's dropped out of college and stopped acting.
She's been arrested, for assaulting Bickle while in a meth-induced rage.
She's been in three different psych wards.

Bickle has spent five years seesawing between hope
and despair.

"Every time she's gotten up to 90 days clean and
sober, she's said to me, 'Thank you for pushing me into rehab. I want to
go to college. I want to study film,'" Bickle says, and her dark eyes
are weary.

"And as soon as she picks up meth again, all
these dreams die. Again."

Because Bickle was tired of feeling helpless, she
made a flier announcing a new organization called "Fight Against Meth."

She faxed her flier to all the media outlets she
could think of, but only one bothered to call her: the Ahwatukee Foothills
News. Bickle lives in north Phoenix.

But the newspaper's short story drew immediate
attention. Bickle started getting e-mails. And phone calls.

Her first meeting drew almost a dozen strangers,
united by stories just like hers: Their daughters were meth addicts. Or
their sons. Or their nieces.

They didn't understand why their kids couldn't stop.
And, even more than that, they didn't understand why it was so hard to
find treatment.

They returned to the topic, unsolicited, at their
second meeting.

"It's like this underground thing,"
explained Paula, whose son is a meth addict. "Who to go to or how to
find a psychiatrist or how to pay for it. No one explains anything."

Once, Paula got her son into rehab only to have her
insurance company cut him off after 10 days.

And though Alice is thrilled that her son is about to
finish a year at an inpatient center in Wickenburg, she's not so thrilled
at the cost: $6,000 a month, without a dime from their insurance company.

The treatment problem is one of the big things that
Fight Against Meth hopes to take on. It's something they've all lived with
-- and something they can't believe no one else is talking about.

One woman, Adell, mentions that she saw an anti-meth
commercial sponsored by County Attorney Andrew Thomas.

The commercial, called "Extreme Meth-Over,"
started airing in November. Using a game-show setup, it shows the nasty
dental work and scabby skin associated with meth use.

It is, according to Thomas' office, the first time
the county attorney has created an anti-drug commercial. But it's a smart
spot, and it drew the women's praise.

"I thought, 'Somebody is doing something,'"
Adell says, pleased.

"Finally, somebody is doing something,"
Paula says.

"Yeah," Adell agrees. "Finally
somebody other than Georganne."

This past summer, Jamie made one more stab at
changing her life. Heavily in debt, spun out, and dealing once more with a
car repossession, she packed up her stuff and moved to Alaska to live with
her dad.

She had no way of getting meth there. She didn't know
anyone in Alaska, much less a dealer, and her dad was watching her like a
hawk.

She got clean, and she felt stronger every day.

But then she started to gain weight. She remembered
how much she'd hated feeling chubby.

"I got so fat," she moans. "I couldn't
stand it."

Unbeknownst to her parents, Jamie persuaded a friend
to book her a ticket home. And once she got home, she called up her old
friends and jumped right back in.

She was awake for four days. Smoking. Getting spun.

She didn't call her mother for two months. She was
too embarrassed.

"I had nothing good to tell her," she says.

Now she's stabilized, a bit, but Jamie will be the
first to tell you that she's balanced in a precarious place. Meth isn't
like pot, where you can use a little and everything works out okay.

One false move, one bad day . . .

She wants to meet a guy and get married and have
kids. Go back to school, get a better job. Work as a drug counselor. Have
a normal life.

But she just can't seem to stop smoking meth. Every
morning, almost every lunch hour.

It's a pattern that could easily destroy her newfound
balance, and she knows it. She wants to get into treatment -- but where?

She shows the scrapbook that she put together in
Alaska. What she wrote then, in that period of new possibility, was
simple, but hopeful.

I am now friendless, jobless, carless. The only thing
I have now is my life and my freedom from something that controlled
everything I thought, I did, and said. . . . TWEAK.

I may be carless, jobless, moneyless, and just have
nothing at all, but I control my life and myself.

That was true, for a moment.

But then Jamie took that plane home to Phoenix. And
then she picked up the meth pipe.

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